Chargemaster 101: Quick Tutorial on a Hospital RCM Essential

Fri, Mar 16, 2018


hospital chargemaster

Curious about the world of chargemasters? These three questions will give you a speedy introduction to this crucial revenue cycle management tool used by hospitals.

1. What Is a Chargemaster?

A hospital chargemaster, also called a hospital charge description master, lists the billable services and items that a hospital provides to patients. Some of the elements included in the chargemaster may include an internally generated identification number for the line, CPT® and HCPCS codes (including alternatives when payers require different codes) with descriptions, the revenue code associated with the charge, and the facility’s charge.

2. How Is a Chargemaster Related to the Revenue Cycle?

A sample, simplified scenario may …

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Physicians Support 12.6 Million Jobs in US, According to AMA Report

Wed, Mar 14, 2018


It’s no secret that healthcare is a major player in the U.S. economy. AMA’s new economic impact report indicates that patient-care physicians are one of the top job creators in the country. According to the report, physicians supported the employment of nearly 12.6 million people and contributed $2.3 trillion to the nation’s economy in 2015.

Each Physician Supports 17.1 Jobs on Average

The report — put together by IQVIA — captures economic data from 2015 pertaining to the country’s 736,873 physicians providing patient care. The report includes both office-based and hospital-based MDs and DOs. The report looked at four key indicators — jobs,

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Understand Screening vs. Diagnostic With This Mammography Coding Snapshot

Mon, Mar 12, 2018


Medicare mammography coding

When the CPT® 2017 code set introduced 77065-77067 for mammography, CMS hung on to HCPCS options G0202, G0204, and G0206 a while longer. But now Medicare accepts the CPT® codes, and the HCPCS options have been sent to the discontinued-code pile. Here’s helpful information on screening vs. diagnostic mammography to help you use the CPT® codes correctly.

Start With Screening Mammography

For screening mammography, use 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed). Medicare Part B covers a screening mammogram once …

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Answer These Questions to Pinpoint the Correct Coronary Atherosclerosis Code

Fri, Mar 9, 2018


I25 coronary atherosclerosis

About a month ago, yet another report came out about whether omega-3 supplements make a difference in cardiovascular disease risk. The findings of this particular meta-analysis were that supplementation may not reduce coronary heart disease in people at high risk of the disease and more study is needed. But while the research continues, plenty of cardiology patients are presenting for treatment of cardiovascular disease, meaning you need to know how to code it. Here are three questions to ask to get you to the correct code for coronary atherosclerosis

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Turn Back Time With These 2018 MPFS Updates

Mon, Mar 5, 2018


Retroactive Medicare fee schedule changes


Keeping up with 2018 updates to the Medicare Physician Fee Schedule (MPFS) is one thing. Knowing which ones are retroactive adds a whole other level to ensuring you’re applying the right information to your claims. Today we’re covering two groups of retroactive MPFS changes.

Watch for Work GPCI Floor Increase

If you’re in an area where the work Geographic Practice Cost Index (GPCI) started 2018 below 1.000, keep an eye on communications from your Medicare contractor. The Bipartisan Budget Act of 2018, passed on Feb. 9, changed the work GPCI floor to 1.000. This is an extension. A previous rule set the floor at 1.000 for …

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Move Over Q1 MUEs … April 1 Changes Are Coming

Thu, Mar 1, 2018


April 2018 MUE updates


Hey, early birds. Have you checked out the Q2 updates to Medically Unlikely Edits (MUEs)? CMS provides spreadsheets showing quarterly updates so you can see the changes and start preparing ahead of time. Here are some highlights from the changes effective April 1, 2018, to existing practitioner MUE values, along with some tips on understanding what MUEs are.

Start With a Quick MUE Refresher

When you look up the MUE for a code, what you’re seeing is the maximum units of service Medicare expects a provider to report for a single beneficiary on a single date of service. Medicare doesn’t create MUEs …

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Can We Expect Medicare Audits to Be Friendlier in 2018?

Wed, Feb 28, 2018


No matter how careful you are, Medicare audits happen — and if the thought of an audit is keeping you awake at night, there could be some good news coming your way! This year, the government is supposedly taking a more lenient and educative approach to rectifying Medicare billing errors.

Background: For some time now, the American Medical Association (AMA) and CMS have been meeting regularly to talk about MACs and RACs.

According to the AMA, most physicians are honest and make a true attempt to comply with Medicare program requirements. But the government’s attempts to address waste, fraud, and …

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Complete This Scavenger Hunt to Rule Path/Lab in 2018

Mon, Feb 26, 2018


looking for 2018 lab coding changes

Every medical specialty has its coding nuances, but pathology and lab coding has to rank near the top when it comes to specialized rules. And just when you thought you’d mastered them all, 2018 came along to add more for you to learn. Ready to test your skills? Below you’ll find a scavenger hunt of sorts with questions and a link to the blog where you’ll find the answer. What’s the prize if you finish? Knowing you’re awesome! Plus cleaner claims, which is a pretty good reward.

Ready, Set, Go!

1. Find the three-letter abbreviation used when talking about duplicate lab codes that …

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Look to .11 When Documentation Shows Substance Abuse ‘In Remission’

Fri, Feb 23, 2018


doctor counseling patient

Substance abuse disorder coding got more detailed options and clarifying notes in the 2018 version of ICD-10-CM. The good news is that now that we’re a few months in, you may have noticed that these changes helped bring your code choices more in line with current clinical practice. Here’s a refresher on how your code choices changed.

Make Sure You’ve Got .11 Options on Cheat Sheets

The added specificity for substance abuse coding means better data collection from ICD-10-CM codes and more accurate information in the patient’s record, too. Specifically, …

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